Human Post-Exposure Rabies Care Related to Bats in Brazil, 2014–2024: Temporal Trends and Regional Inequalities.
DOI:
https://doi.org/10.36557/2674-8169.2026v8n8p1010-1134Keywords:
Rabies, Bats, Post-Exposure Prophylaxis, Epidemiological Surveillance, ZoonosesAbstract
Introduction: Rabies remains a highly lethal zoonosis, and bats have assumed increasing importance in the epidemiology of the disease in Brazil. Post-exposure prophylaxis (PEP) is essential for preventing human cases, but its effectiveness depends on timely care, completion of the indicated regimen, and the appropriateness of the recorded management.
Objective: To analyze bat-related rabies post-exposure care in Brazil from 2014 to 2024, focusing on temporal trends, regional inequalities, timeliness of care, treatment abandonment, active follow-up, and concordance of recorded management.
Materials and Methods: This retrospective observational study was based on records from the Brazilian Notifiable Diseases Information System (SINAN). A total of 62,099 bat-related post-exposure records were analyzed. Descriptive analyses, Poisson regression with robust variance, and Prais-Winsten models were used to assess temporal trends.
Results: Among 61,960 records with a chronologically valid exposure-to-care interval, 48.3% received care on the same day as exposure, while 10.2% had an interval longer than seven days. The North region had the highest proportions of delayed care (>2 days: 40.6%; >7 days: 28.2%). Among records with known treatment interruption status, 13.5% were classified as abandonment. Among abandonment records with available information on active follow-up, active follow-up was recorded in 79.5%. In the conservative concordance cohort, 22.7% of records had potentially discordant management according to national recommendations. The annual number of records increased significantly (APC=7.8%; 95% CI: 1.6–14.4%; p=0.019), whereas indicators of delayed care, abandonment, and potentially discordant management remained stationary.
Conclusion: The increase in recorded post-exposure care was not accompanied by proportional improvement in the main care indicators. Relevant regional inequalities persisted, particularly in the North region, indicating the need to strengthen timely access, continuity of PEP, and data quality.
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References
World Health Organization. Rabies [Internet]. Geneva: World Health Organization; 2024 [cited 2026 Jul 23].
World Health Organization. Rabies vaccines and immunization [Internet]. Geneva: World Health Organization; [cited 2026 Jul 23].
Pan American Health Organization. World Rabies Day 2024: breaking rabies boundaries [Internet]. Washington, DC: PAHO; 2024 [cited 2026 Jul 23].
Schneider MC, Romijn PC, Uieda W, Tamayo H, da Silva DF, Belotto A, et al. Fifty years of the National Rabies Control Program in Brazil under the One Health perspective. Pathogens. 2023;12(11):1342. doi:10.3390/pathogens12111342.
Vargas A, Romano APM, Merchan-Hamann E. Human rabies in Brazil: a descriptive study, 2000-2017. Epidemiol Serv Saude. 2019;28(2):e2018275. doi:10.5123/S1679-49742019000200001.
Catozo RG, et al. Two decades of human rabies in Brazil: epidemiological trends, emerging risks and treatment challenges. Rev Soc Bras Med Trop. 2025;58:e0110-2025. doi:10.1590/0037-8682-0110-2025.
Carvalho-Costa FA, Tedesqui VL, de Jesus Nascimento Monteiro M, Boia MN. Outbreaks of attacks by hematophagous bats in isolated riverine communities in the Brazilian Amazon: a challenge to rabies control. Zoonoses Public Health. 2012;59(4):272-277. doi:10.1111/j.1863-2378.2011.01444.x.
de Paula Silva N, de Andrade EA, Cardoso D, Guimaraes RCS, Silva MB, Nascimento KKG, et al. Assessment of crab fishermen's exposure to rabies virus in a typical Amazonian community. Zoonoses Public Health. 2021;68(8):973-981. doi:10.1111/zph.12869.
Bastos V, Mota R, Guimaraes M, Richard Y, Lima AL, Casseb A, et al. Challenges of rabies surveillance in the Eastern Amazon: the need of a One Health approach to predict rabies spillover. Front Public Health. 2021;9:624574. doi:10.3389/fpubh.2021.624574.
Rocha F, et al. Pre-exposure prophylaxis to prevent hematophagous bat-mediated rabies outbreaks in remote Amazon communities: lessons from a pilot for public health policy. Trop Med Infect Dis. 2024;9(8):179. doi:10.3390/tropicalmed9080179.
Estima NM, Wada MY, Rocha SM, Moraes DS, Ohara PM, Vargas A, Assis DM. Description of human anti-rabies post-exposure prophylaxis care notifications in Brazil, 2014-2019. Epidemiol Serv Saude. 2022;31(2):e2021627. doi:10.1590/S2237-96222022000200004.
Freitas TCR, Soares AB, Figueiredo BNS. Evaluation of prophylaxis protocols and spatial distribution of humans wounded by bats: a descriptive study, Palmas, 2013-2023. Epidemiol Serv Saude. 2026;35:e20250557. doi:10.1590/S2237-96222026v35e20250557.en.
da Silva RM, et al. Factors limiting the appropriate use of rabies post-exposure prophylaxis by health professionals in Brazil. Front Vet Sci. 2022;9:846994. doi:10.3389/fvets.2022.846994.
Andrade BFMC, Queiroz LH, Marinho M. Human anti-rabies care in the State of Sao Paulo: evaluating prophylaxis conduct in individuals attacked by dogs and cats. Rev Soc Bras Med Trop. 2024;57:e004202024. doi:10.1590/0037-8682-0170-2023.
Brazil. Ministry of Health. Orientações para profissionais de saúde: raiva [Internet]. Brasília: Ministry of Health; [cited 2026 Jul 23]. Available from: Ministério da Saúde — Orientações para profissionais de saúde: raiva
Brazil. Ministry of Health. Sistema de Informação de Agravos de Notificação. Dicionário de dados – SINAN Net, versão 5.0: atendimento antirrábico [Internet]. Brasília: Ministry of Health; [cited 2026 Jul 23]. Available from: SINAN — Atendimento Antirrábico
Brazil. Ministry of Health. Normas tecnicas de profilaxia da raiva humana [Internet]. Brasilia: Ministry of Health; 2014.
Brazil. Ministry of Health. Technical Note No. 8/2022-CGZV/DEIDT/SVS/MS: updates to the protocol for pre-exposure, post-exposure, and re-exposure prophylaxis of human rabies in Brazil [Internet]. Brasilia: Ministry of Health; 2022.
Brazil. National Health Council. Resolution No. 510, April 7, 2016 [Internet]. Brasilia: National Health Council; 2016.
Brazil. National Health Council. Resolution No. 674, May 6, 2022 [Internet]. Brasilia: National Health Council; 2022.
Brazil. National Research Ethics Commission. Circular Letter No. 12, July 27, 2023: guidance on research using publicly accessible information [Internet]. Brasilia: National Research Ethics Commission; 2023.
Kisaka S, Makumbi F, Majalija S, Bahizi G, Thumbi SM. Delays in initiating rabies post-exposure prophylaxis among dog bite victims in Wakiso and Kampala districts, Uganda. Open Res Afr. 2022;4:49. doi:10.12688/aasopenres.13311.3.
Romero-Sandoval N, Parra C, Gallegos G, et al. Haematophagous bat bites in the Ecuadorian Amazon: characterisation and implications for sylvatic rabies prevention. Public Health Action. 2013;3(1):85-89. doi:10.5588/pha.12.0070.
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Copyright (c) 2026 Matheus Gonçalves Maués, Victória Amin, Júlia Costa, Yasmin Imbiriba, Giovana Lima, André Lima
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